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Radiographics. Author manuscript; available in PMC 2020 May 27.
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Published in final edited form as:

Radiographics. 2019 ; 39(5): 1435–1436. doi:10.1148/rg.2019190087.

BI-RADS, C-RADS, CAD-RADS, LI-RADS, Lung-RADS, NI-RADS,

O-RADS, PI-RADS, TI-RADS: Reporting and Data Systems
Julie Y. An, MD, Kyle M. L. Unsdorfer, MD, Jeffrey C. Weinreb, MD
Department of Medicine, Summa Health Systems–Akron City Hospital, Akron, Ohio (J.Y.A.);
Department of Radiology, Mayo Clinic, Rochester, Minn (K.M.L.U.); and Department of Radiology,
Yale University School of Medicine, New Haven, Conn (J.C.W.).
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The American College of Radiology (ACR)–endorsed Reporting and Data Systems (RADS)
are guidelines for the evaluation and interpretation of disease-oriented imaging studies. Each
system is devised by a group of experts in consensus and may be periodically updated to
improve diagnostic parameters. Standardized reporting is preferred by referring physicians
because it minimizes reporting variations and ambiguous terminology. Furthermore, the
systematic nature of the ACR RADS allows consistent data collection. These qualities are
critical for facilitating outcomes monitoring and for postadoption refinements and quality
assurance.

The RADS are both modality and technique specific. All but one system, the Ovarian-
Adnexal Reporting and Data System (O-RADS), use a stepwise numerical scoring system
that corresponds to the degree of disease suspicion. Certain systems also allow modifiers to
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convey specific details, such as inadequate examination, negative examination, posttreatment

findings, and non–disease-related findings. Certain systems also offer follow-up
recommendations for each associated category. These recommendations add value to our
reports and have the potential to improve practice standards across institutions.

The prototype system Breast Imaging Reporting and Data System (BI-RADS) was first
published by the ACR in 1993 to address the lack of uniformity in mammography reporting.
As of mid-2019, there are nine systems with full ACR endorsements and several new
systems in various stages of development (Figure). BI-RADS (breast cancer; mammography,
MRI, and US), C-RADS (colon cancer; CT colonography), LI-RADS (liver cancer; MRI,
CT, US, and contrast-enhanced US), Lung-RADS (lung cancer; low-dose CT), NI-RADS
(head and neck cancers; PET, CT, and MRI), O-RADS (adnexal masses; US), PI-RADS
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(prostate cancer; MRI), and TI-RADS (thyroid cancer; US) focus on malignancy, while
CAD-RADS (CT angiography) focuses on coronary artery disease.

Address correspondence to J.Y.A., Department of Radiology, University of California San Diego, 200 W Arbor Drive, San Diego,
CA 92103 (j1an@[Link]).
Disclosures of Conflicts of Interest.—
J.C.W. Activities related to the present article: member of the ACR LI-RADS and PI-RADS committees; received reimbursement for
travel expenses for committee meetings from the ACR. Activities not related to the present article: disclosed no relevant relationships.
Other activities: disclosed no relevant relationships.
The author J.C.W has provided disclosures (see end of article); all other authors have disclosed no relevant relationships.
 An et al. Page 2

Because the various types of RADS are disease specific, there are inherent structural
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differences among the systems. Major differences include whether the study indication is for
screening or diagnostic purposes, if scores are given per lesion or per patient, and the range
of numbers included in the scoring categories. A summary of the nine systems and their key
features is shown in the Figure. The primary literature is listed in the suggested readings.

In the online presentation, each system is individually reviewed. The scores or categories for
each system are described, and imaging findings, management recommendations, and image
examples for each are provided.

Clinical adoption of the ACR RADS varies greatly among radiologists, institutions, and
practices. BI-RADS followed by PI-RADS and LI-RADS have gained the greatest
acceptance and interest, as demonstrated by each of their sizeable and growing publication
records. Further integration of RADS into clinical society guidelines, as demonstrated by
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BI-RADS with the American Society of Breast Surgeons and LI-RADS with the American
Association for the Study of Liver Diseases, has potential to increase the use and impact
radiology has on clinical care. Expert lectures and interactive cases are provided for more in-
depth system-specific training.

Acknowledgments.—
The authors would like to thank Philip Araoz, MD, Wan Koo, MD, and Baris Turkbey, MD, for their guidance and
review of this presentation.

Abbreviations:
ACR American College of Radiology
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RADS Reporting and Data Systems

Suggested Readings
American College of Radiology. Liver Reporting and Data Systems (LI-RADS). [Link]
Clinical-Resources/Reporting-and-Data-Systems/LI-RADS. Accessed June 4, 2019.
Andreotti RF, Timmerman D, Benacerraf BR., et al. Ovarian-Adnexal Reporting Lexicon for
Ultrasound: A White Paper of the ACR Ovarian-Adnexal Reporting and Data System Committee.
Journal of the American College of Radiology 2018;15(10):1415–1429. [PubMed: 30149950]
Cavazuti B, Hudgins P, Rath T, et al. Neck Imaging Reporting and Data System: An Atlas of NI-
RADS Categories for Head and Neck Cancer. American College of Radiology. Accessed June 4,
2019.
Cury RC, Abbara S, Achenbach S, et al. CAD-RADS Coronary Artery Disease: Reporting and Data
System—An expert consensus document of the Society of Cardiovascular Computed Tomography
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(SCCT), the American College of Radiology (ACR) and the North American Society for
Cardiovascular Imaging (NASCI): Endorsed by the American College of Cardiology. J Cardiovasc
Comput Tomogr 2016;10(4):269–281. [PubMed: 27318587]
D’Orsi CJ, Sickles EA, Mendelson EB et al. ACR BI-RADS atlas, Breast Imaging Reporting and Data
System. Reston, Va: American College of Radiology, 2013.
Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, et al. ACR Thyroid Imaging, Reporting
and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. Journal of the
American College of Radiology 2017; 14(5):587–595. [PubMed: 28372962]

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Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, Margolis D, Schnall MD,
Shtern F, Tempany CM, et al. PI-RADS Prostate Imaging: Reporting and Data System: 2015,
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Version 2. Eur Urol 2016;69(1):16–40. [PubMed: 26427566]

Zalis ME, Barish MA, Choi JR et-al. CT colonography reporting and data system: a consensus
proposal. Radiology 2005; 236(1):3–9. [PubMed: 15987959]
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TEACHING POINTS
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• The ACR-endorsed RADS are expert-devised guidelines for the evaluation

and interpretation of disease-oriented imaging studies.

• The majority of systems are related to cancer imaging, with BI-RADS, PI-
RADS, LI-RADS, and TI-RADS being the most widely accepted by
radiologists and speciality physicians.

• Because the various types of RADS are disease specific, there are inherent
structural and scoring differences to be aware of when first applying these
systems in practice.
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Figure.
Overview of nine ACR RADS as of midyear 2019. C = prior lung cancer; C-RADS = CT
Colonography Reporting and Data System; CAD-RADS = Coronary Artery Disease
Reporting and Data System; CEUS = contrast-enhanced US; HCC = hepatocellular
carcinoma; LI-RADS = Liver Imaging Reporting and Data System; M = malignant but not
HCC; N, NC = nondiagnostic; NI-RADS = Neck Imaging Reporting and Data System; PI-
RADS = Prostate Imaging Reporting and Data System; S = clinically significant or
potentially clinically significant findings (nonlung cancer); TI-RADS = Thyroid Imaging
Reporting and Data System; TIV = tumor in vein; TR = treated.
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Radiographics. Author manuscript; available in PMC 2020 May 27.